Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia

Abstract

Background: Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults. Methods: This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation. Results: A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%–17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: −2.6 days, 95% CI: −4.3 to −1; P = 0.001), a slower respiratory rate at the time of extubation (mean difference: −2.3 breath/min, 95% CI: −3.8 to −1; P = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001–0.04; P = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%–30.5%; P = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002–1.03; P = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01–1.1; P = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 – 1.1; P < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006–0.5; P = 0.02). Conclusion: Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.

Keywords

• adverse effects
• airway extubation
• critically ill
• mechanical ventilation
• reintubation
• risk factors